MEDICARE: WELLSTAR RHEUMATOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician

General Provider Information

NPI Number	:	1528386349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSTAR RHEUMATOLOGY, LLC

Provider Business Mailing Address
First Line	:	4480 N COOPER LAKE RD SE
Second Line	:	SUITE 201
City	:	SMYRNA
State	:	GA
Zip	:	30082-4622
Country	:	US
Telephone Number	:	770-792-5275
Fax Number	:	770-941-6466

Provider Business Practice Location Address
First Line	:	4480 N COOPER LAKE RD SE
Second Line	:	SUITE 201
City	:	SMYRNA
State	:	GA
Zip	:	30082-4622
Country	:	US
Telephone Number	:	770-792-5275
Fax Number	:	770-941-6466

Authorized Official
Title or Position	:	ASSISTANT VP OF FINANCE
Name	:	NICOLE ASHE
Credential	:
Telephone Number	:	770-792-5261

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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